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Short Height

What is short Height
How Height grows
Causes of short Height
Approach to diagnosis of Short Stature
Investigations & Diagnosis
Short height due to Growth hormone deficiency
Treatment
Medicines to increase Height
Growth hormone therapy
Other hormone therapy
Operations for height increase

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What is short Height (Dwarfism) i.e. short height is defined when child is short compared to others, the moment you feel your child is shorter than others you should consult the doctor immediately otherwise later you may not have enough time for treatment.

How Height grows: In children the various hormones (as growth hormone, Thyroid Hormone, sex hormones, adrenal hormone androstenidione, 17-oh Progesterone, DHEAS, LH, FSH, plays the role in height increase. Also many minerals, nutrients also required for good height growth. These hormones, minerals & micronutrients lead to increased concentration of IGF-1 & some other hormones. These hormones then act on the various sensors (called receptors) in the growth plate of bone. After the interaction of hormones & receptors certain changes occurs in the functioning of cells of growth plate of long bones tissue so that growth plate cells starts growing in thickness & size & more & more new bone starts depositing in the bone thus growth plate size gradually starts increasing. Simultaneously it also increases the blood supply to growth plate tissue leading to more availability of growth factors to the growth plate tissue resulting in faster growth of growth plate tissue. These hormones & growth factors are in high concentration during peak of secondary sexual characters development i.e. puberty leading to persistent stimulation of growth plate for next two to three years i.e. up to completion of sexual development. Thus in children in two to three years full height growth occurs. 

Causes of short height are:

Hormone Disorder: Growth hormone deficiency, thyroid hormone deficiency, cortisol excess, 
Mineral Disorder: Vitamin D, Zinc, Calcium, Iron deficiency, osteomalacia, rickets, hereditary (genetic) 

Rickets (Vitamin D deficiency or hypophosphataemic 
Skeletal dysplasia: (Achondroplasia, Hypochondroplasia) 
Chromosomal defect (as Downs's Syndrome, Turner Syndrome), 

Systemic Diseases: CNS, Cardiac diseases, Renal tubular acidosis, kidney failure & Chronic Systemic diseases ,Chronic Renal disease : CRF, RTA , Hematologic disease :Anemia d/t Thallasemia major sickel cell anemia ,Uncontrolled Diabetes ,Cardiac disease: Cynotic heart disease, CHF d/t any cause. 
many other causes 
Familial short stature (genetic), Constitutional delayed growth with or without delayed puberty, 
Malnutrition, anemia, Under nutrition (of calorie, protein, vitamin-D & Zinc)
Dysmorphic syndromes (Primordial dwarf):Russel Silver Syndrome,Noonan Syndrome ,Praderwilli Syndrome ,Pseudohypoparathyroidism , LMB Synd., Progeria , Intrauterine growth retardation 
Psycho-social Dwarfism 
Malabsorption: Celiac diseases, chron’s disease & Chronic Giardiasis., 
Inborn errors of Metabolism (Mucopolysacharidosis, Galactosemia) 
CNS Disease: Mental retardation
Idiopathic Short Stature 

Approach to Diagnosis of Short Stature 


Detailed History: First we take detail history about diet, past illness & other relevant history to reach on probable cause for shortness of height. Birth history (breech delivery, preterm), Height, Weight at birth, Early developmental milestones, Scholastic performance, Dietary intake (in present & past) 
Any systemic disease (in present & past), History suggestive of Hypothyroidism, Cushing’s disease or syndrome, Growth hormone deficiency, History of steroid intake Psycho-social history, Family history of Short height & delayed growth & puberty (in parents, 1st & 2nd degree relatives) Old height & weight records. 

Physical Examination:
We look for anemia, signs of malnutrition, Rickets, Neck for goiter, then we do Systemic examination- Organomegaly & CVS, Respiratory system, Central Nervous system is examined for any cause in CNS & Intellect, Fundus for Papilloedema &optic-atrophy. We also Look for signs of Growth hormone deficiency, Hypothyroidism, for congenital anomalies in face, neck, hand, chest, leg & body for primordial dwarf, turner syndrome, Measure Weight, calculate weight age, calculate relationship of weight age to height age.
If weight for height is less (weight. age less than height. age) i.e. child is underweight the chance of Nutritional short height or malabsorption as cause is more likely. If weight for height is more (i.e. weight. age > height. age) then chances of endocrine i.e. hormone disorder as cause for short height is more likely. 

Investigation & Diagnosis:

After detail history & examination whatever hormone deficiency is suspected is investigated. 
For this we do following tests:
Hormone test: as growth hormones, thyroid (Free T4, Free T3, TSH), FSH, LH, testosterone, estradiol, IGF-1, IGFBP-3,etc. 
Bio-chemical test: (Hb., ESR, GBP, Alkaline.Phosphatase, Calcium, Phosphorus, Urea, creatinine, Urine Protein, M/E ,Fasting urinary ph , Serum bicarbonate,Serum Potassium ,Serum protein, SGPT Stool Fat ,
Tests to diagnose other systemic diseases
x-ray Skull,
Bone age (skeletal age) test 

Short height due to Growth hormone deficiency:
Growth hormone deficiency is one of the common causes of short height. Growth hormone formation becomes less in body due to inability of growth hormone secreting glands to make GH hormone from birth due to defect in gland functioning itself which is called congenital growth hormone deficiency. Then other cause are those cases in which growth hormone deficiency occurs later in life due to some damage to growth hormone forming gland later in life such as due to idiopathic growth hormone deficiency , tumour or trauma. G.H. ineffectiveness, hypopituitarism, Isolated growth hormone deficiency, Biologically inactive growth hormone, acquired idiopathic growth hormone deficiency, psychosocial deprivation syndrome.

Clinical Feature: During infancy or childhood child may suffer with recurring irritability due to low blood sugar, Prolonged jaundice, small genital, 
cryptorchidism in male, During Child hood children with growth hormone deficiency present with short height, Childish look, obesity with prominent abdominal adiposity, prominent forehead, lower face is small, normal intelligence, normally active, and normal body proportions & no other disease that would cause growth failure, sexual development is also often delayed, wrinkling of face or body, fatigue (Weakness), depression & decreased body strength, bone weakness etc. Diagnosis of short height due to growth hormone deficiency is made by low GH, IGF-1, IGF-BP-3

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